Clinical Question

Is honey an effective treatment for acute cough in children?

Evidence-Based Answer

For patients one to 18 years of age, providing honey for cough symptoms can reduce the frequency and severity of cough, as well as improve sleep for patients and parents, when compared with placebo or no treatment. Honey is no better than dextromethorphan for symptom control. (Strength of Recommendation: A, based on consistent, good-quality patient-oriented evidence.)

Practice Pointers

Acute cough in children is a common reason for primary care visits. It is a source of anxiety for patients and parents, and may impact quality of life during the course of illness. From 1999 to 2006, approximately one child in 10 took an over-the-counter (OTC) cold medication in any given week.1 However, there is a lack of evidence demonstrating the effectiveness of OTC or prescription medications for cough in patients younger than four years. These treatments often include dextromethorphan and diphenhydramine, which have potential adverse effects such as respiratory depression, hallucinations, dry mouth, and tachycardia. The authors of this review set out to determine whether honey is a safe and effective treatment for acute cough in children.

This Cochrane review included three small, randomized controlled trials with 568 children one to 18 years of age. Studies compared the mean difference (MD) of caregiver symptom scores for acute cough before and after treatment with honey, diphenhydramine, dextromethorphan, placebo, or no treatment on a scale from 0 to 6 (with lower scores signifying better symptoms). Cough frequency was reduced with honey vs. no treatment (MD = −1.05; 95% confidence interval [CI], −1.48 to −0.62; n = 154) and placebo (MD = −1.85; 95% CI, −3.36 to −0.33; n = 300). There was no difference when honey was compared with dextromethorphan for cough frequency, although honey was slightly better than diphenhydramine (MD = −0.57; 95% CI, −0.9 to −0.24; n = 80). Overall, honey was no better than any of the other interventions for bothersome cough, although one study indicated that it may be better than placebo (MD = −2.08; 95% CI, −3.97 to −0.19; n = 300). The groups were not stratified by age, making it difficult to establish effectiveness among different ages of children. Cough duration was not included in the analysis because the studies examined only one night of symptoms for participants.

Use of honey was associated with some adverse effects, such as nervousness, insomnia, and hyperactivity, although these occurrences were not statistically significant. Because of a lack of immunity against Clostridium botulinum, infants younger than one year should not be given honey.

In 2006, the American College of Chest Physicians recommended that children, especially those younger than two years, should not receive OTC cough medication because there were no clear benefits and definite potential harms.2 This was later supported by the U.S. Food and Drug Administration and the American Academy of Pediatrics, both of whom recommended raising the minimum safe age for cough medications to four years.3,4 The findings in this study support honey as an alternative to the standard cough medications.